Healthcare Provider Details

I. General information

NPI: 1881362028
Provider Name (Legal Business Name): KIALYNNE BLAND BCBA, COBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23645 MERCANTILE RD STE B
BEACHWOOD OH
44122-5936
US

IV. Provider business mailing address

23645 MERCANTILE RD STE B
BEACHWOOD OH
44122-5936
US

V. Phone/Fax

Practice location:
  • Phone: 888-830-1672
  • Fax:
Mailing address:
  • Phone: 888-830-1672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-74855
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: